Provider Demographics
NPI:1538346028
Name:ANN ARBOR MARKET LLC
Entity type:Organization
Organization Name:ANN ARBOR MARKET LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:JONNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-706-1600
Mailing Address - Street 1:30777 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 N MAPLE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2824
Practice Address - Country:US
Practice Address - Phone:734-827-3000
Practice Address - Fax:734-827-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
MI53010087883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2370740OtherNCPDP PROVIDER IDENTIFICATION NUMBER